|
CLOSE OF RECTOVAGINAL FISTULA
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
76102189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.41 |
| Max. Negotiated Rate |
$1,347.09 |
| Rate for Payer: Aetna Commercial |
$1,347.09
|
| Rate for Payer: Ambetter Exchange |
$918.43
|
| Rate for Payer: Anthem Medicaid |
$495.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$918.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$918.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,102.12
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,284.23
|
| Rate for Payer: Healthspan PPO |
$1,304.33
|
| Rate for Payer: Humana Medicaid |
$495.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$918.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$918.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.32
|
| Rate for Payer: Molina Healthcare Passport |
$495.41
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.96
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$918.43
|
|
|
CLOSE OF RECTOVAGINAL FISTUL(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
761P2189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.41 |
| Max. Negotiated Rate |
$1,347.09 |
| Rate for Payer: Aetna Commercial |
$1,347.09
|
| Rate for Payer: Ambetter Exchange |
$918.43
|
| Rate for Payer: Anthem Medicaid |
$495.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$918.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$918.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,102.12
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,284.23
|
| Rate for Payer: Healthspan PPO |
$1,304.33
|
| Rate for Payer: Humana Medicaid |
$495.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$918.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$918.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.32
|
| Rate for Payer: Molina Healthcare Passport |
$495.41
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.96
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$918.43
|
|
|
CLOSE VESICOVAGINAL FISTULA
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 51900
|
| Hospital Charge Code |
76102078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$689.18 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,331.53
|
| Rate for Payer: Ambetter Exchange |
$779.94
|
| Rate for Payer: Anthem Medicaid |
$689.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$779.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$779.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$935.93
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$1,199.56
|
| Rate for Payer: Healthspan PPO |
$1,064.68
|
| Rate for Payer: Humana Medicaid |
$689.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,114.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$779.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$779.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.96
|
| Rate for Payer: Molina Healthcare Passport |
$689.18
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,013.92
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$696.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$779.94
|
|
|
CLOSE VESICOVAGINAL FISTULA
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 51900
|
| Hospital Charge Code |
76102078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
CLOSE VESICOVAGINAL FISTULA
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 51900
|
| Hospital Charge Code |
76102078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
CLOSE VESICOVAGINAL FISTULA(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 51900
|
| Hospital Charge Code |
761P2078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$689.18 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,331.53
|
| Rate for Payer: Ambetter Exchange |
$779.94
|
| Rate for Payer: Anthem Medicaid |
$689.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$779.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$779.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$935.93
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$1,199.56
|
| Rate for Payer: Healthspan PPO |
$1,064.68
|
| Rate for Payer: Humana Medicaid |
$689.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,114.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$779.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$779.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.96
|
| Rate for Payer: Molina Healthcare Passport |
$689.18
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,013.92
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$696.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$779.94
|
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
76102564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem Medicaid |
$80.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$181.74
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Humana KY Medicaid |
$80.13
|
| Rate for Payer: Kentucky WC Medicaid |
$80.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.77
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
76102564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna Commercial |
$179.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$181.74
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna Commercial |
$193.39
|
| Rate for Payer: First Health Commercial |
$221.35
|
| Rate for Payer: Humana Commercial |
$198.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.04
|
| Rate for Payer: Ohio Health Group HMO |
$174.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.77
|
| Rate for Payer: PHCS Commercial |
$223.68
|
| Rate for Payer: United Healthcare All Payer |
$205.04
|
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
IP
|
$235.00
|
|
| Hospital Charge Code |
45000336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
OP
|
$235.00
|
|
| Hospital Charge Code |
45000336
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 44620
|
| Hospital Charge Code |
76101859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 44620
|
| Hospital Charge Code |
76101859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 44620
|
| Hospital Charge Code |
76101859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,237.24 |
| Rate for Payer: Aetna Commercial |
$1,237.24
|
| Rate for Payer: Ambetter Exchange |
$819.03
|
| Rate for Payer: Anthem Medicaid |
$473.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$819.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$819.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$982.84
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,144.44
|
| Rate for Payer: Healthspan PPO |
$1,043.39
|
| Rate for Payer: Humana Medicaid |
$473.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$819.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$819.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.39
|
| Rate for Payer: Molina Healthcare Passport |
$473.91
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.74
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$819.03
|
|
|
CLOSURE ENTEROSTOMY - LRG/SM(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 44620
|
| Hospital Charge Code |
761P1859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,237.24 |
| Rate for Payer: Aetna Commercial |
$1,237.24
|
| Rate for Payer: Ambetter Exchange |
$819.03
|
| Rate for Payer: Anthem Medicaid |
$473.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$819.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$819.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$982.84
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,144.44
|
| Rate for Payer: Healthspan PPO |
$1,043.39
|
| Rate for Payer: Humana Medicaid |
$473.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$819.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$819.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.39
|
| Rate for Payer: Molina Healthcare Passport |
$473.91
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.74
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$819.03
|
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
76101860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$661.34 |
| Max. Negotiated Rate |
$1,468.43 |
| Rate for Payer: Aetna Commercial |
$1,468.43
|
| Rate for Payer: Ambetter Exchange |
$955.78
|
| Rate for Payer: Anthem Medicaid |
$661.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$955.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,146.94
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,365.06
|
| Rate for Payer: Healthspan PPO |
$1,238.36
|
| Rate for Payer: Humana Medicaid |
$661.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$955.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.57
|
| Rate for Payer: Molina Healthcare Passport |
$661.34
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.51
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$955.78
|
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
76101860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
76101860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CLOSURE OF ENTEROSTOMY - LAR(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 44625
|
| Hospital Charge Code |
761P1860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$661.34 |
| Max. Negotiated Rate |
$1,468.43 |
| Rate for Payer: Aetna Commercial |
$1,468.43
|
| Rate for Payer: Ambetter Exchange |
$955.78
|
| Rate for Payer: Anthem Medicaid |
$661.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$955.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,146.94
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,365.06
|
| Rate for Payer: Healthspan PPO |
$1,238.36
|
| Rate for Payer: Humana Medicaid |
$661.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$955.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.57
|
| Rate for Payer: Molina Healthcare Passport |
$661.34
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.51
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$955.78
|
|
|
CLOSURE OF EYELID BY SUTURE
|
Facility
|
IP
|
$3,892.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
76102392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,167.68 |
| Max. Negotiated Rate |
$3,736.59 |
| Rate for Payer: Aetna Commercial |
$2,997.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,035.98
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cigna Commercial |
$3,230.59
|
| Rate for Payer: First Health Commercial |
$3,697.67
|
| Rate for Payer: Humana Commercial |
$3,308.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,191.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,872.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,425.21
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.67
|
| Rate for Payer: PHCS Commercial |
$3,736.59
|
| Rate for Payer: United Healthcare All Payer |
$3,425.21
|
|
|
CLOSURE OF EYELID BY SUTURE
|
Facility
|
OP
|
$3,892.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
76102392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.91 |
| Max. Negotiated Rate |
$3,736.59 |
| Rate for Payer: Aetna Commercial |
$2,997.06
|
| Rate for Payer: Anthem Medicaid |
$1,338.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$894.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,035.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,252.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.13
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cigna Commercial |
$3,230.59
|
| Rate for Payer: First Health Commercial |
$3,697.67
|
| Rate for Payer: Humana Commercial |
$3,308.44
|
| Rate for Payer: Humana KY Medicaid |
$1,338.56
|
| Rate for Payer: Humana Medicare Advantage |
$894.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,191.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,872.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,365.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,425.21
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.67
|
| Rate for Payer: PHCS Commercial |
$3,736.59
|
| Rate for Payer: United Healthcare All Payer |
$3,425.21
|
|
|
CLOSURE OF EYELID BY SUTURE
|
Professional
|
Both
|
$3,892.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
76102392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$2,335.37 |
| Rate for Payer: Aetna Commercial |
$130.56
|
| Rate for Payer: Ambetter Exchange |
$88.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$88.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.42
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cigna Commercial |
$126.14
|
| Rate for Payer: Healthspan PPO |
$198.42
|
| Rate for Payer: Humana Medicaid |
$88.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.69
|
| Rate for Payer: Molina Healthcare Passport |
$88.91
|
| Rate for Payer: Multiplan PHCS |
$2,335.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.28
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.68
|
|
|
CLOSURE OF EYELID BY SUTURE(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761P2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$130.56
|
| Rate for Payer: Ambetter Exchange |
$88.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$88.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.42
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$126.14
|
| Rate for Payer: Healthspan PPO |
$198.42
|
| Rate for Payer: Humana Medicaid |
$88.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.69
|
| Rate for Payer: Molina Healthcare Passport |
$88.91
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.28
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.68
|
|
|
CLOSURE OF EYELID BY SUTURE(T
|
Facility
|
OP
|
$3,112.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761T2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.91 |
| Max. Negotiated Rate |
$2,987.79 |
| Rate for Payer: Aetna Commercial |
$2,396.46
|
| Rate for Payer: Anthem Medicaid |
$1,070.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$894.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,427.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,252.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.13
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cigna Commercial |
$2,583.19
|
| Rate for Payer: First Health Commercial |
$2,956.67
|
| Rate for Payer: Humana Commercial |
$2,645.44
|
| Rate for Payer: Humana KY Medicaid |
$1,070.31
|
| Rate for Payer: Humana Medicare Advantage |
$894.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,552.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,091.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,738.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,334.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,489.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,707.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,147.47
|
| Rate for Payer: PHCS Commercial |
$2,987.79
|
| Rate for Payer: United Healthcare All Payer |
$2,738.81
|
|
|
CLOSURE OF EYELID BY SUTURE(T
|
Facility
|
IP
|
$3,112.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761T2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$933.68 |
| Max. Negotiated Rate |
$2,987.79 |
| Rate for Payer: Aetna Commercial |
$2,396.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,427.58
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cigna Commercial |
$2,583.19
|
| Rate for Payer: First Health Commercial |
$2,956.67
|
| Rate for Payer: Humana Commercial |
$2,645.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,552.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,738.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,334.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,489.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,707.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,147.47
|
| Rate for Payer: PHCS Commercial |
$2,987.79
|
| Rate for Payer: United Healthcare All Payer |
$2,738.81
|
|
|
CLOSURE OF MEDIAN STERNOTOMY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
76100406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
